ultrasound in regional anesthesia

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
U

USAnesthesiaDoc

Full Member
10+ Year Member
15+ Year Member
Joined
Nov 30, 2006
Messages
67
Reaction score
0
I am a private practice doc, doing tons of regional anesthesia but just starting to learn it with ultrasound. I thought it might be a good idea to start a new thread regarding this. Ultrasound was just starting to be used right after I finished residency so I'm basically self-teaching myself now. Would like to discuss technique, particularly helpful tricks for placing catheters with ultrasound. Maybe we should start with talking about femoral nerve catheters since they are common and relatively easier to do. What brand ultrasound machines are people using? Are you placing catheters/blocks with nerve stimulation in addition to ultrasound or just using ultrasound by itself? When you place the catheter, do you bolus first or only bolus through the catheter? Looking forward to this thread.
Members don't see this ad.
 
We don't like regional in this forum.

Ok, maybe it's just me.
 
USAnesthesiaDoc said:
I am a private practice doc, doing tons of regional anesthesia but just starting to learn it with ultrasound. I thought it might be a good idea to start a new thread regarding this. Ultrasound was just starting to be used right after I finished residency so I'm basically self-teaching myself now. Would like to discuss technique, particularly helpful tricks for placing catheters with ultrasound. Maybe we should start with talking about femoral nerve catheters since they are common and relatively easier to do. What brand ultrasound machines are people using? Are you placing catheters/blocks with nerve stimulation in addition to ultrasound or just using ultrasound by itself? When you place the catheter, do you bolus first or only bolus through the catheter? Looking forward to this thread.
Click to expand...

I think these are excellent questions. At our institution, we do a ton of regional and most of it by US. We have a Sonosite (not the newest software upgrade that allows a TEE probe), but a pretty good one. It works good. We just got a logiq book GE (the newest) and it is phenomenal. We also have the previous version GE and it absolutely sucks.

I suggest getting the DVD that University of Utah puts out. It has a great approach - it shows gross anatomy, then picture anatomy, then the ultrasound image of each block. The US images are wonderful (and they have the Logiq book GE US machine). It uses split imaging so that you can see the ultrasound image, and where the probe is on the patient.

As far as using stim with ultrasound, I like this because it adds information and takes nothing more to do. I can't see a down side. It really confirms that you are looking at the musculocutaneous nerve (for example) instead of just a white spot. Some people only us US though. This doesn't apply to the Fascia Iliaca catheter placement. I never use stim for that.

The flooty tooties at ASRA and some big institutions all feel like they have mastered stimulation, so they are slow to use ultrasound. I suppose this is okay, since they are so good at what they do already.

As far as catheters, I like using the flex tip (with coiled wire) from the epidural kits because they show up so nicely under ultrasound. The stiff braun catheters made in regional kits don't show up so nice.

I think you should always use long axis when starting out. You can usually find the needle tip this way, as opposed to short axis.

Finally, if you can get your place to purchase Pajunk (spelling) ultrasound opake needles - do this. These are absolutely wonderful. The light up the screen and you can't miss your needle. They are very fun to use.

As far as bolusing before or after catheter placement......good question.
 
Members don't see this ad :)
Thanks, epiduralman!

I've been so far been mainly doing femoral nerve single injection blocks with u/s, always use stimulation and always use long-axis view (of the needle) so far. I've been very impressed with how quickly and profoundly the block sets up with u/s versus just stim technique. I have noticed, however, that it is often difficult to locate the needle shaft (have been using 21G braun stimuplex needles), seem to have to be lined up perfectly, but maybe I should try the brand you suggested with the opaque needles.

Our hospital owns several sonosite machines (utilized by breast and vascular surgeons) that I have borrowed for the femoral blocks. It comes with only 1 probe that allows you to choose res, gen, or pen for resolution. I can visualize the femoral vessels/nerve well with this, but when I've imaged the neck just looking for the brachial plexus on volunteers, I've definitely had more trouble defining that. Tried a subgluteal sciatic once with u/s, but couldn't find that at all. Also tried a posterior approach popliteal and was finally able to id the sciatic but only b/c I was using stimulation as well. The nerve became obvious once I id'd it with stimulation but if I hadn't had that, don't think I would have really found it. Wonder if it was my transducer? I also attended an u/s regional conference put out by sonosite, so of course, those machines were pushed, and thus far, they are my only experience.

Any good references to read about u/s guided placement of fascia iliaca catheters?

Interestingly, several of the pain guys at my institution had been doing femoral catheters for total knees using only stimuating catheters (no u/s), but the success rate was only about 50% and the blocks were very time intensive, so they ultimately abandoned it. Any thoughts on why this would be? One of the guys told me he would place the catheter and always bolused after it was placed. It seems more simple to me to bolus local first, and then float the catheter.
 
The University of Utah used to, and perhaps still does run classes on U/S guided regional anesthesia and I thought I heard they included the DVD with the class. Their postgrad conference at Park City includes quite a bit of regional as well as TEE (and skiing).

Bolus then place the catheter. You'll create a space with the local, and the catheter will place easier. If you're having a hard time locating your needle, give a small shot of local and look as you inject.
 
USAnesthesiaDoc said:
I've been so far been mainly doing femoral nerve single injection blocks with u/s, always use stimulation and always use long-axis view (of the needle) so far. I've been very impressed with how quickly and profoundly the block sets up with u/s versus just stim technique. I have noticed, however, that it is often difficult to locate the needle shaft (have been using 21G braun stimuplex needles), seem to have to be lined up perfectly, but maybe I should try the brand you suggested with the opaque needles.
Click to expand...

The proper terminology for ultrasound blocks.

"long" or "short" axis refers to the target nerve and it's appearance on the screen (or the blood vessel for a line). Long axis means the target nerve is travelling across the screen. Short axis means it is travelling perpendicular to the plane of the beam.

"in plane" and "out of plane" refers to the view of the needle. "In plane" is when you watch the entire length of the needle on screen moving from the left or the right towards the target in the middle. "Out of plane" refers to the needle moving perpendicular to the plane of the ultrasound beam and you only see a small dot on the screen for the needle.


What you seem to be describing is an in plane, short axis view of the femoral nerve for the block (nerve in short axis view, needle in plane).


I realize it's a small point, but since ultrasound is not routinely used in anesthesia we might as well keep the terminology correct.
 
Mman said:
The proper terminology for ultrasound blocks.

"long" or "short" axis refers to the target nerve and it's appearance on the screen (or the blood vessel for a line). Long axis means the target nerve is travelling across the screen. Short axis means it is travelling perpendicular to the plane of the beam.

"in plane" and "out of plane" refers to the view of the needle. "In plane" is when you watch the entire length of the needle on screen moving from the left or the right towards the target in the middle. "Out of plane" refers to the needle moving perpendicular to the plane of the ultrasound beam and you only see a small dot on the screen for the needle.


What you seem to be describing is an in plane, short axis view of the femoral nerve for the block (nerve in short axis view, needle in plane).


I realize it's a small point, but since ultrasound is not routinely used in anesthesia we might as well keep the terminology correct.
Click to expand...

Thanks for the clarification. I hadn't heard that before. I've been using the wrong terms.
 
epidural man said:
I think these are excellent questions. At our institution, we do a ton of regional and most of it by US. We have a Sonosite (not the newest software upgrade that allows a TEE probe), but a pretty good one. It works good. We just got a logiq book GE (the newest) and it is phenomenal. We also have the previous version GE and it absolutely sucks.

I suggest getting the DVD that University of Utah puts out. It has a great approach - it shows gross anatomy, then picture anatomy, then the ultrasound image of each block. The US images are wonderful (and they have the Logiq book GE US machine). It uses split imaging so that you can see the ultrasound image, and where the probe is on the patient.

As far as using stim with ultrasound, I like this because it adds information and takes nothing more to do. I can't see a down side. It really confirms that you are looking at the musculocutaneous nerve (for example) instead of just a white spot. Some people only us US though. This doesn't apply to the Fascia Iliaca catheter placement. I never use stim for that.

The flooty tooties at ASRA and some big institutions all feel like they have mastered stimulation, so they are slow to use ultrasound. I suppose this is okay, since they are so good at what they do already.

As far as catheters, I like using the flex tip (with coiled wire) from the epidural kits because they show up so nicely under ultrasound. The stiff braun catheters made in regional kits don't show up so nice.

I think you should always use long axis when starting out. You can usually find the needle tip this way, as opposed to short axis.

Finally, if you can get your place to purchase Pajunk (spelling) ultrasound opake needles - do this. These are absolutely wonderful. The light up the screen and you can't miss your needle. They are very fun to use.

As far as bolusing before or after catheter placement......good question.
Click to expand...


Very nice post.
 
So I guess i am one of the FlootyTooty docs but I haven't used much less needed US yet. I haven't had an unsuccessful block in over 3 yrs and I include the continuous catheters in this statement.

With that being said, my partners feel we should get a US device (they are all very good at regional). I said it was their choice and that I would give it a go if we got one. I will still use stimulation but i suspect that i will not use it for long and only for difficult cases like traumatic deformities or the like.

As far as catheters, i bolus at least half of my dose b/4 passing the catheter. Then give the rest via the catheter. Works every time.
 
Noyac, when you are doing a block with a catheter using only nerve stimulation, do you do anything differently with the needle placement compared to a single shot nerve block? IE, do you use a different angle, different entry point, etc? Could you comment on femorals, interscalenes, popliteals, and sciatics? Thanks!
 
So what does recent research show about DISADVANTAGES to ultrasound guided regional anesthesia?
 
We do a lot of infraclavicular blocks at our institution w/ US Guidance. It is a great technique b/c you can clearly see the lung and vessels--and avoid them.

We bolus first and then thread the catheter. We have a high success rate with our blocks.

Lefty
 
Members don't see this ad :)
How often are people tunnelling catheters? Do you do this most of the time, sometimes, or not at all? Seems like an extra step that may not be worth the time, plus uncomfortable for the patient?
 
USAnesthesiaDoc said:
Noyac, when you are doing a block with a catheter using only nerve stimulation, do you do anything differently with the needle placement compared to a single shot nerve block? IE, do you use a different angle, different entry point, etc? Could you comment on femorals, interscalenes, popliteals, and sciatics? Thanks!
Click to expand...

It depends on which way I want the catheter to travel. IE: the interscalene block I want the catheter to tunnel caudad so the bevel of the needle is aimed that way. THe axillary, infraclavicular and femoral I want the catheter to pass cephalad so the bevel is upright. My angle doesn't really change from single shots to continuous. But once in position I may drop the angle a little more if the catheter doesn't pass easily. I bolus before threading the cath which usually makes the cath thread easily
 
One issue that I have with ultrasound...

Some of our attendings like to do things like supraclav or interscalene or femoral with a stimulating needle and ultrasound. Well, what do you do with conflicting info? Suppose I'm getting a great pic on ultrasound that looks like it's in perfect position but the stimulation isn't right. Or what if the stimulation is right, but it doesn't look right on ultrasound.

The answer doesn't seem cut and dry, although theoretically it should be safer and higher success rate using both.
 
Mman said:
One issue that I have with ultrasound...

Some of our attendings like to do things like supraclav or interscalene or femoral with a stimulating needle and ultrasound. Well, what do you do with conflicting info? Suppose I'm getting a great pic on ultrasound that looks like it's in perfect position but the stimulation isn't right. Or what if the stimulation is right, but it doesn't look right on ultrasound.

The answer doesn't seem cut and dry, although theoretically it should be safer and higher success rate using both.
Click to expand...
You always go with the stimulation.
 
nimbus said:
I am +- US for most blocks but it is awesome for A-lines when no pulse is palpable.
Click to expand...

If you learn to feel the rope or cord or whatever you want to call it of the artery you can hit it without a pulse as well.
 
see, I've at times gone with the U/S pic and had great success even if the stimulation wasn't right. With the U/S you can actually see the local spreading around all sides of the nerve and you can use less volume to get the same great block.

With other attendings, we go for the stimulation and not the pic.

It's a little weird, but both ways tend to work.
 
Mman said:
see, I've at times gone with the U/S pic and had great success even if the stimulation wasn't right. With the U/S you can actually see the local spreading around all sides of the nerve and you can use less volume to get the same great block.

With other attendings, we go for the stimulation and not the pic.

It's a little weird, but both ways tend to work.
Click to expand...

If you see a shadow that looks like a nerve on ultrasound but you are not getting the right response to nerve stimulation, then that shadow is not a nerve!
 
May sound trivial, but I use the US for pt's w/a difficult IV b4 resorting to a central, or poking around blind multiple times. It saves the pt tons of risk/pain to get a PIV w/an accurate view.
In terms of regional, I love my little US machine. They guy I'm working with now likes regional, and prefers to use US. His name is Dr Perov, and is apparently very well known in the community for his expertise w/regional. I do about 2-4 blocks/day w/him, and so far have went blind only on one w/a stimucath, 80%US and stim, and 20% just US. He uses diff anesthetics for the same block depending on how he feels, the surgeons speed, and pt indications. I've used mepiv, chlorpro for ax blocks, all single-shot, I have yet to develop a preference. I don't remember the specifics, but I'll post 'em when I get a sec next week. Not many fem blox, but will post experience w/them later.
Personally, I like the stimulator b/c despite seeing the nerves on the US, a little more confirmation never hurts, and I like seeing the response of the muscle to stimulation. Of course, I always tell the pt prior to poking that when I'm in the right place they may jerk around a bit, and that it's completely nl(even though they may be snowed a bit). US combined w/stim is nice b/c you have a visual aid to guide you, ie less searching, and you can confirm it w/the stimulation.
Working with this dude has me considering a regional fellowship despite the heavy non-regional slant of this board. In fact, I think regional is the way of the future :scared: flame on.

One more thing about US. We recently had a lecture for US eval of vertebral spacing prior to epidural, and the jist was that this dept uses US for every pt prior to placement. Lot's of routine easy backs, but for the 15% or so that are tough 2/2 anatomy/bony abn/fat etc... it makes it easier to find a good location to enter. No added expenses b/c it's the same machine that's used for OB US anyway, and the pt is spared the "little poke n burn" speech that you give even after the 3rd attempt.
 
Anyone have any thoughts on tunnelling catheters, ie do you or don't you for the most part?

Also, assuming your block is strictly for post-op pain management (you're doing light general or spinal for the anesthetic) and you place a catheter, when you bolus local before threading the catheter, do you use a long-acting local like marcaine or ropivacaine just in case your catheter is unsuccessful or do you use a fast-onset local to confirm your block works?
 
Can't agree more with a previous poster about regional anesthesia being the wave of the future. It's already becoming a standard of care for the most part.
 
Planktonmd said:
If you see a shadow that looks like a nerve on ultrasound but you are not getting the right response to nerve stimulation, then that shadow is not a nerve!
Click to expand...


I'll disagree. There are times when it is plainly obvious that it is a nerve, but just not getting the exact stimulation that you would otherwise look for. And you can still do the block and it works perfectly (and I can't explain 100% why).

I like that with ultrasound you can use smaller volumes of local and just watch the entire nerve get encircled with local.
 
USAnesthesiaDoc said:
How often are people tunnelling catheters? Do you do this most of the time, sometimes, or not at all? Seems like an extra step that may not be worth the time, plus uncomfortable for the patient?
Click to expand...


We have come to the conclusion that tunnelling is a waste of time. Half the time you will dislodge the catheter trying to tunnel it. It is a high risk (catheter getting pulled) low benefit (doesn't really secure it that much better) procedure. We use dermabond around the catheter insertion site, benzoin, and three loops. This holds it pretty well and doesn't leak that much (because of the dermabond).
 
Planktonmd said:
If you see a shadow that looks like a nerve on ultrasound but you are not getting the right response to nerve stimulation, then that shadow is not a nerve!
Click to expand...
This is not necessarily true. There is a really informative and interesting website www.neuraxiom.com, which addresses this (along with some articles that are referenced).
 
lvspro said:
Working with this dude has me considering a regional fellowship despite the heavy non-regional slant of this board. In fact, I think regional is the way of the future :scared: flame on.
Click to expand...

Funny thing is a few years back nobody was doing regional. Now with the sonogram everybody wants to do it. I don't think it's the future. It's the present. Personally, I hate it. When I applied to residency I looked for program that did a lot of it. I wanted to be good at it. Big mistake. I trained with no U/S, so failure was rather high. When it works, it works well. I just couldn't deal with more than 5% failure rate. I hated having to set up for both general and regional. I hated that there were no kits, so you had to scavenge stuff all over the place. I hated that the attendings were always guiding you through the block, from your very first one to your last. How come that does not happen with intubations, which happen to be more important than sticking a needle? I hated that the regional attendings were total useless douche bags with no knowledge of anesthesia.

I realized early on during residency that I didn't go into anesthesia to make sure Mr Johnson had no nausea, or a pain score of zero. I did it because if it weren't for me Mr Johnson would be a dead body by now. Regional would never be able to give me that satisfaction.

If you draw satisfaction from having a comfortable pt at the end of a low risk procedure, by all means go for it.
 
urgewrx said:
Funny thing is a few years back nobody was doing regional. Now with the sonogram everybody wants to do it. I don't think it's the future. It's the present. Personally, I hate it. When I applied to residency I looked for program that did a lot of it. I wanted to be good at it. Big mistake. I trained with no U/S, so failure was rather high. When it works, it works well. I just couldn't deal with more than 5% failure rate. I hated having to set up for both general and regional. I hated that there were no kits, so you had to scavenge stuff all over the place. I hated that the attendings were always guiding you through the block, from your very first one to your last. How come that does not happen with intubations, which happen to be more important than sticking a needle? I hated that the regional attendings were total useless douche bags with no knowledge of anesthesia.

I realized early on during residency that I didn't go into anesthesia to make sure Mr Johnson had no nausea, or a pain score of zero. I did it because if it weren't for me Mr Johnson would be a dead body by now. Regional would never be able to give me that satisfaction.

If you draw satisfaction from having a comfortable pt at the end of a low risk procedure, by all means go for it.
Click to expand...

Now thats interesting. So you were not very good at regional techniques and you blame your attendings. You don't like that they don't make a tray for your blocks, my nurses have a card for what I want for each type of block and everything is ready. Don't we all prevent the "dead body"? Its just that some of us add a few other things to our anesthetic, like no nausea and pain free.

Now I know where the idea that we don't like regional here comes from. :thumbdown:
 
USAnesthesiaDoc said:
This is not necessarily true. There is a really informative and interesting website www.neuraxiom.com, which addresses this (along with some articles that are referenced).
Click to expand...

A recent article (I can't remember where) on ultrasound and regional showed that a small number of times, people are injecting into the nerve without knowing it. There wasn't morbidity associated with it.

There also is that study where they stick the needle right in the middle of the sciatic nerve (of pigs) and the pigs sometimes have no twitch!

When I was at the ASA last year, there was a guy that had jimmy-rigged a nerve stimulated that I thought was REALLY cool. It had a series of 3 quick pulses (instead of 1) with varying pulse width on each pulse, so the current density at the tip would decrease with each pulse (of the 3). So as you approached the nerve, when you were semi-close, you would get a twitch-pause-twitch-pause, as you normally would. But as you got closer, you when then get twitch-twitch-pause...twitch-twitch-pause, and then even closer you would get all three. He said it really helped you zone in quickly.

I thought it sounded great. The problem I have with twitch monitor (and obviously others do to because that is why the guy made that twitcher) is that you can have a good twitch, take a deep breath and the twitch would disappear and you swear you didn't move the damn needle. It is infuriating. I guess that is what years of practicing does, but I would like to try the 3 pulses thing.
 
Interesting stuff.
So we did 3 ax blox so far, no stim, US guided, 1.5%mepiv, 20,20,10cc single shot, and all three worked like a charm.

btw, we use the GE US w/all the bells n whistles.
 
I think that's great that you're considering a regional fellowship. Joint replacements and orthopedic surgery in an aging population aren't going anywhere and you will be primed to take advantage with regional anesthesia. I am 2 years out of residency, and kind of wish I had done one. However, it's a fast-changing field, and I'm having fun with it. Thinking of joining the OAPRS; you should check out their website www.oaprs.org. I mostly do regional anesthesia on an average day, but also am partnership track and take lots of call, so I'm quite facile and comfortable with other types of anesthesia like vascular and thoracic. If you're a good anesthesiologist, you're a good anesthesiologist and can take care of almost any type of patient with almost any type of anesthetic. :)
 
urgewrx said:
What's wrong with the good old ASRA? Why do we need another society? Is that the competition to the NYSORA?
Click to expand...
We may not need another society; however, this one focuses on regional anesthesia and acute pain management for orthopedic surgery. This is my bread and butter and very interesting to me, so I am looking into it and thought others might be interested as well.
 
Noyac said:
If you learn to feel the rope or cord or whatever you want to call it of the artery you can hit it without a pulse as well.
Click to expand...
Funny you should mention that b/c one of my CA-3 buddies is doing a case report on something along these lines. He actually was trying to drop in a femoral line after one fell out of a pt that just had an open AAA repair, and had trouble palpating a fem pulse(or any other LE pulses for that matter), so tried localizing w/an US. US showed a non-pulsatile artery. Surgery was paged, pt went back in to THE OR TO HAVE AN AORTIC CROSS-CLAMP REMOVED!! This was one of those cases where the surgery residents walked away saying "thank god for those anesthesiologists" instead of complaining about our lounge, hours, or pay etc...
 
Planktonmd said:
If you see a shadow that looks like a nerve on ultrasound but you are not getting the right response to nerve stimulation, then that shadow is not a nerve!
Click to expand...


Use Anisotropy. tendons and muscle/facia will tend to dissappear as you tilt the probe, but nerves stay in picture.

Try this in the carpal tunnel - identify the median nerve and some tendons and then tip the probe slightly (anisotropy) and you will see the tendons drop out but the nerve remains.
 
Mman said:
One issue that I have with ultrasound...

Some of our attendings like to do things like supraclav or interscalene or femoral with a stimulating needle and ultrasound. Well, what do you do with conflicting info? Suppose I'm getting a great pic on ultrasound that looks like it's in perfect position but the stimulation isn't right. Or what if the stimulation is right, but it doesn't look right on ultrasound.

The answer doesn't seem cut and dry, although theoretically it should be safer and higher success rate using both.
Click to expand...

Similar experience here. I'd go with the picture if you're certain you're looking at your target. Had one experience where picture looked great but no stim....kept advancing the needle and got a HUGE parasthesia but still no stim...good way to injure a nerve! If you're certain your are looking at the nerve you are aiming to block...go with the picture!

BTW...best techniqe in my opinion is to view the nerve short axis and needle on long axis. It's VERY difficult to visualize the needle on short axis, even more difficult to view the needle tip. Long axis just play with the probe a bit and you can see your needle bevel!

GE U/s much better than sonosite.
 
GeddyLee said:
Similar experience here. I'd go with the picture if you're certain you're looking at your target. Had one experience where picture looked great but no stim....kept advancing the needle and got a HUGE parasthesia but still no stim...good way to injure a nerve! If you're certain your are looking at the nerve you are aiming to block...go with the picture!

BTW...best techniqe in my opinion is to view the nerve short axis and needle on long axis. It's VERY difficult to visualize the needle on short axis, even more difficult to view the needle tip. Long axis just play with the probe a bit and you can see your needle bevel!

GE U/s much better than sonosite.
Click to expand...

Can you comment on why you prefer the GE? Easier to use, better picture, better service, fewer service calls?
 
lvspro said:
Funny you should mention that b/c one of my CA-3 buddies is doing a case report on something along these lines. He actually was trying to drop in a femoral line after one fell out of a pt that just had an open AAA repair, and had trouble palpating a fem pulse(or any other LE pulses for that matter), so tried localizing w/an US. US showed a non-pulsatile artery. Surgery was paged, pt went back in to THE OR TO HAVE AN AORTIC CROSS-CLAMP REMOVED!! This was one of those cases where the surgery residents walked away saying "thank god for those anesthesiologists" instead of complaining about our lounge, hours, or pay etc...
Click to expand...

you gotta be sh***ing me. those clamps are huge! must have been a vessel loop around the iliac or something.

"the patient tolerated the procedure well and the needle and instrument count was correct per the nursing staff times two. end of dictation."
 
USAnesthesiaDoc said:
Can you comment on why you prefer the GE? Easier to use, better picture, better service, fewer service calls?
Click to expand...

Yes..image quality is insanely good! Interface is easier to us than the sonosite as well. Can't tell you about service though.
 
Bigeleisen PE. Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury.[see comment]. [Journal Article. Research Support, Non-U.S. Gov't] Anesthesiology. 105(4):779-83, 2006 Oct.
UI: 17006077
 
USAnesthesiaDoc said:
Can you comment on why you prefer the GE? Easier to use, better picture, better service, fewer service calls?
Click to expand...

The GE Logiq book E has two technologies that improve the image over Sonosite (I think - I may be talking out my arse, but we just had a ultrasound specialist come talk to us about it. He said he loves teaching on the GE over the sonosite.) One is called crossbeam, and I don't remember the other one. GE is coming out with a new model or software upgrade very soon. I may have mentioned but one cool thing about the new sonosite is you can buy a TEE probe for it.
 
You must log in or register to reply here.
Next unread thread

Similar threads

C
Billing for ultrasound for regional anesthesia
Replies
1
Views
479
potcake76
P
P
Regional Anesthesia Fellowship Lifestyle (UCSF specifically)
Replies
10
Views
2K
DrN2O
D
PeterGriffin
Ultrasound recommendations
Replies
5
Views
660
PeterGriffin
PeterGriffin
luster
  • Locked
Peds Cardiac Anesthesia Apprenticeship?
Replies
17
Views
1K
Arch Guillotti
Arch Guillotti
L
Ultrasound for IVs
Replies
30
Views
2K
nimbus
nimbus
Top